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Please be at least 15-30 minutes early to your appointment so that we can register you and fill out any necessary paperwork. We kindly ask that you bring any medications—both prescription and over the counter—to your visits so that we can provide you the most comprehensive care possible. A detailed list of medications is also welcomed. Please have the name of the medications, doses, and instructions on your list when you arrive for your appointment.

Forms

You can print and complete these forms prior to your appointment, or visit our patient portal and complete the forms online.

Form Fees

  • Paper Management Fee: $10.00
  • FMLA Form: $30.00
  • Dictation of Letter: $15.00 correspondence on patient’s behalf
  • Insurance Form: $25.00
  • History and Physical Letter: $50.00 Minimum
  • Assisted Living/Nursing Home Form: $30.00
  • VIA form (not the license place card) ***Needs Office Visit***

Payment is required in full at the time of service. We accept:

  • Cash
  • Check
  • Visa
  • Mastercard

Medication Refill Requests

  • We kindly ask that medication refill requests be made only during dedicated office hours. To do this, please call your pharmacy and have them send us a refill request for your medication.
  • Medication cannot be refilled after hours or on weekends and/or holidays.
  • Please allow at least two to five business days for refills, and plan ahead for weekends and holidays.
  • New prescriptions will be started at office visits only.
  • Any request for a prescription change from a long distance pharmacy will be decided at your next office visit.

Treatment of Minors

SAMA requires written consent from a legal parent or guardian if they do not accompany the minor to the appointment. The adult accompanying the minor is responsible for full payment at the time of service.

Appointment Cancellation and Late/No Show Policy

We may you call in advance as a courtesy to confirm your appointment. It is still the patients responsibility to manage his/her appointments regardless if a call was received. If you need to cancel an appointment, please give 24 hours notice. If you do not cancel your appointment 24 hours in advance, you will be charged a fee of $40.00 for routine office visit and $50.00 for a comprehensive visit (e.g. Physical Examination).

SAMA allows for patients to check in up to 20 minutes past their scheduled appointment time. Patients will then be marked as a no show and be charged a fee of $40.00 for a routine office visit and $50.00 for a comprehensive visit (e.g. Physical Examination).  If the patient wishes to still be seen by a provider a same day slot must be available and a co-pay (if applicable) will be collected.

Insurance

We accept a wide range of insurances. Please call your insurance company beforehand to make sure SAMA is in your network.

If you are a new patient, please call your insurance prior to your visit and make sure that you change your primary care physician over to your new SAMA physician to avoid delays at the registration desk.